Comparison of contemporary staging systems for oropharynx cancer in a surgically treated multi-institutional cohort.

BACKGROUND: Between the publication of the Union of International Cancer Control staging system (UICC) 7th and 8th editions, other staging algorithms for oropharyngeal squamous cell carcinoma (OPSCC) were proposed from Radiation Therapy Oncology Group (RTOG), MD Anderson Cancer Center (MDACC), and Yale University. METHODS: With C-statistics, the above-mentioned five staging algorithms were compared for overall and relapse-free survival endpoints in a multi-institutional cohort of OPSCC cases (n = 338) treated with primary surgery. RESULTS: Pathological UICC 8th ed yielded the highest C-indexes in the entire cohort and in the HPV- subset, whereas MDACC was superior for HPV+ OPSCC. RTOG was the simplest and holistic algorithm with a noninferior discriminatory power. CONCLUSION: UICC 8th ed, MDACC, and RTOG offer moderate and comparable efficacy for staging in this OPSCC patient cohort undergoing surgical treatment. Notable discrepancy between clinical and pathological UICC 8th ed algorithms poses potential concerns in diagnosis, treatment, research, and data management.

Impact of human papillomavirus on outcome in patients with oropharyngeal cancer treated with primary surgery.

BACKGROUND: Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cell carcinoma (SCC) is limited. The purpose of this study was to identify influential factors on survival in a large cohort of patients with surgically treated oropharyngeal SCC. METHODS: Retrospective analysis of survival estimates in patients with surgically treated oropharyngeal SCC using tumoral positivity for human papillomavirus (HPV) and risk-of-death categories according to a study from 2010 as stratification factors. RESULTS: The 5-year overall survival (OS) and disease-specific survival (DSS) rates after surgery alone were higher in HPV-associated oropharyngeal SCC (OS 80% vs 62%; P = .01; DSS 92% vs 76%; P = .03). Patients in the low-risk category had higher survival rates (OS 91%; DSS 99%) than patients in the intermediate-risk group (OS 63%; DSS 83%), and high-risk group (OS 61%; DSS 75%). CONCLUSION: Nonsmokers with HPV-positive oropharyngeal SCC have a better prognosis than smokers with HPV-positive oropharyngeal SCC and also than patients with HPV-negative tumors when treated by surgery alone.

Diagnostic value of core needle biopsy and fine-needle aspiration in salivary gland lesions.

BACKGROUND: Core needle biopsy (CNB) has gained acceptance as a minimally invasive procedure in the head and neck. Nevertheless, many concerns arise regarding the value and safety of this method in the assessment of salivary gland lesions. METHODS: This prospective study comprises 111 patients with a salivary gland lesion. The results of ultrasound-guided CNB were compared with those of fine-needle aspiration (FNA) in the 103 histologically verified cases. RESULTS: CNB achieved a higher accuracy than FNA in identifying true neoplasms (98% vs 91%) and detecting malignancy (99% vs 87%), and was also superior to FNA providing a specific diagnosis (93% vs 74%). In both methods, no complications, such as bleeding, infection, nerve injury, or tumor-cell seeding, occurred. CONCLUSION: CNB is a simple, safe, and highly accurate procedure, which should be considered as an additional diagnostic tool in the assessment of salivary gland lesions. © 2015 Wiley Periodicals, Inc. Head Neck 38: E346-E352, 2016.

Value of narrow band imaging in the early diagnosis of laryngeal cancer.

BACKGROUND: Narrow band imaging (NBI) is a new imaging technique for the depiction of tumor-specific neoangiogenesis. The purpose of the present study was to assess the value of NBI in the early diagnosis of laryngeal cancer. METHODS: This prospective study includes 205 consecutive patients with a laryngeal lesion scheduled for microlaryngoscopy. NBI was immediately performed after white light endoscopy (WLE), whereas excisional biopsy was carried out for histologic verification of diagnosis. RESULTS: In identifying laryngeal cancer and its precursor lesions, NBI with WLE showed a significantly higher sensitivity (97% vs 79%) and accuracy (97% vs 90%) than WLE alone, but the specificity (96% vs 95%) was essentially equal in both methods. CONCLUSION: NBI qualifies for rapid detection and delineation of suspicious lesions. Additionally, this noninvasive method is also beneficial in a variety of benign lesions.

Role of ultrasound-guided core-needle biopsy in the assessment of head and neck lesions: a meta-analysis and systematic review of the literature.

BACKGROUND: Core-needle biopsy (CNB) has occasionally been used in the work-up of head and neck lesions. However, no systematic review of this simple, minimally invasive method has yet been performed. METHODS: A systematic review of the literature and meta-analysis of data extracted from 16 included studies were performed. A total of 1291 cervical lesions in 1267 patients were examined by CNB. This resulted in 1232 adequate samples, from which 554 were subsequently confirmed by excisional biopsy. RESULTS: CNB was able to identify true neoplasms and detect malignancy in head and neck lesions with an overall accuracy of 94% and 96%, respectively, even though there was a significant difference between the histologically verified and all adequate samples. CNB provided a correct specific diagnosis in 87% of cases without major complications and achieved a higher accuracy than that of fine-needle aspiration in detecting malignancy. CONCLUSIONS: This meta-analysis confirms that CNB is an excellent method in the assessment of salivary gland lesions and lymphadenopathies inclusive of malignant lymphoma, but it is not ideal for evaluating thyroid lesions.

Anatomical landmarks for endosonography of the larynx.

BACKGROUND: A precise knowledge of anatomy is necessary to allow a correct interpretation of sonographic images when investigating a particular region of the body. The objective of the present study was to establish anatomical landmarks for endosonography of the larynx. METHODS: In an experimental study, a total of 32 normal human larynges were examined endosonographically, and the classical landmarks were correlated to horizontal whole-organ sections of the scanned specimens. RESULTS: All laryngeal specimens showed a similar and reproducible sonoanatomy, which could be verified consistently on corresponding histological cross sections. Anatomical structures readily identified included the laryngeal framework, the vocal ligament, the vocal muscle, the ventricular fold, the preepiglottic and paraglottic space, and the epiglottis. CONCLUSIONS: Due to a reproducible sonoanatomy of the larynx, endosonography might be an interesting complementary tool in the diagnostic investigation of laryngeal lesions such as medium-sized tumors, cysts, laryngoceles, and stenoses.

Comparison of ultrasound-guided core-needle biopsy and fine-needle aspiration in the assessment of head and neck lesions.

BACKGROUND: Core-needle biopsy (CNB) has been successfully applied in other medical specialties, but its value is undetermined in otolaryngology. METHODS: This prospective study includes 75 patients, who were seen at our institution with a cervical mass. The results of CNB were compared with those of fine-needle aspiration (FNA) in the 68 histologically verified cases. RESULTS: CNB was superior to FNA providing a specific diagnosis (90% vs 66%) and achieved a higher accuracy in identifying true neoplasms (100% vs 93%) and detecting malignancy (99% vs 90%). However, the sensitivity and specificity did not differ significantly between both methods. CONCLUSIONS: Sonography and if necessary FNA should continue to be the investigation method of first choice for head and neck lesions. The main indication for CNB is after repeated failures of FNA to provide a diagnosis. It can also be performed in patients who are not surgical candidates or in those who refuse surgery.